#11 Circadian Rhythm & Shift work

#11 Circadian Rhythm & Shift workBy : Dewi Hardiningtyas, ST., MT., MBA.Industrial Engineering Dept. – University of Brawijaya

How did you feel afterwards?

• Definition Natural physiologicalcycle the body goes throughevery day

• Function best during the daylighthours (4am-6pm), sleep best atnight (6pm-4am).

• Cycle correlates with :

• sleepiness

• sleep efficiency (how long wesleep)

• performance

• errors and accidents

• There is a built in body clock which controls body temperature, alertness, muscle strength, digestion, hormone secretion, blood pressure, immediate & long term memory, kidney function etc.

Causes of Sleep Loss

• deliberately staying awake

• sleeping at unnatural times

• during daylight

• counter to one’s circadian rhythms

• sleeping with the effects of caffeine or alcohol

Effects of Sleep Disruption

• impaired judgement

• reduced ability to learn

• reduced ability to store new material

• inability to plan

• A standardized scale used by sleep experts

• Assess your chance of dozing

• 0 would never dose

• 1 slight chance of dozing

• 2 moderate chance of dozing

• 3 high chance of dozing

• Scale : National Sleep Foundation

• get more sleep!

• some sleep is better than no sleep

• napping (even 15 minutes) is proven to improve performance

• caffeine for short runs

• avoiding shift work or planning it properly

FACTS! : Victorian driver crash and fatal crash rates during the day (6am to 10pm) and night (10pm to 6am) by license type (VicRoads, 2005)

• The highest risk of death for young drivers involvedin road crashes

• Study results :• People inexperienced young drivers

• Time during the night-time hours; especially nearingmidnight and into the early morning hours, and duringthese times on weekends.

• Reasons :• poorer visual information,

• fatigue and alcohol

• “recreational” driving

• less likely to use their seat belt

• Young drivers also drive more at night compared to adultdrivers

• Solutions : support for restrictions• Night-time driving restrictions are effective and should

apply to first-year Provisional drivers from at least 11pmto 5am, with administrative exceptions.

• Shift work is work scheduled, eitherpermanently or frequently outside normaldaytime working hours (7 am.- 6 pm,) e.g. :

• Permanent work at night

• Permanent work during evening

• Afternoon or evening shifts

• Shifts beginning before 6 am.

• Work hours with changing assignment patterns.

Permanent Nights• Most permanent night workers never

really get used to the schedule

• Many nights they feel tired and sleepy

• Fatigue because of return to day hours on days off

• Family and friends active during the day

• Errands and chores during the day

• Sleep less during the day

Rotating Shifts• Can never adapt to a set work

schedule

• Used to be more “fair” to all workers

• Rotating shift workers have more complaints than others about physical and psychological health

• Special Risks

• Speed

• The number of consecutive days before a shift change

• Rotation

• Longer rotations (3-4 weeks) may allow better adaptation to shift

• Shorter (1-2 days) allows no time to get used to night shift, but can get through it quickly to get to rest day. Used more in Europe than US

• Direction

• Forward or clockwise (day-evening-night)

• Reverse (day-night-evening)

• Work-Rest Ratio

• If an 8 hour shift = 16 hours to do everything else and sleep

• If a 12 hour shift, only 12 hours to do everything else.

• Family duties do not decrease no matter the shift time leading to less sleep and rest

• Fatigue is cumulative

• Health care workers with emergencies or covering call

• A factory breakdown or last minute rush order

• A last minute “call board” assignment to move an order

• Being on call and getting called in (Doctors do know about this!)

• This is a fixed (no rotation) plan that uses 2 teams and two 12-hr shifts to provide 24/7 coverage. One team will be permanently on the day shift and the other will be on the night shift.

• This is a fast rotation plan that uses 3 teams

• Two 12-hr shifts to provide 24/7 coverage.

• Each team rotates through the following sequence every three days: 1 day shift, 1 night shift, and 1 day off.

• This is a fast rotation plan that uses 4 teams

• Three 8-hr shifts to provide 24/7 coverage

• Each team rotates through a sequence of 2 day shifts, 2 swing shifts, 2 night shifts, and 2 days off over an 8-day cycle.

• This is a fast rotation plan that uses 4 teams • Three 8-hr shifts to provide 24/7 coverage. • Each team rotates through a sequence of 2, 2, and 3 consecutive day shifts, swing shifts,

night shifts, or days off. • Week 1: 2 day shifts, 2 swing shifts, 3 night shifts• Week 2: 2 days off, 2 day shifts, 3 swing shifts• Week 3: 2 night shifts, 2 days off, 3 day shifts• Week 4: 2 swing shifts, 2 night shifts, 3 days off

• Circadian De-synchronisation: shift work is counter to circadianrhythms

• Issues: alertness, hunger patterns, urinary patterns, quality ofsleep, cardiac health, asthma

• Shifts are easier for younger person, older people have lessphysiological capacity to adapt shift work.

• Solutions :• permanent assignment (people don’t usually like this)

• slow rotation

• fixed for 2-3 weeks then time to resynchronize between shifts

• Definition : if we work in the night shift but our body rhythm is in day mode

• When we sleep in day after night work : • Body temperature is increasing.

• Digestive enzyme secretion is increasing.

• Body metabolism is increasing.

• Sleep is very difficult even if we are tired.

• Leads to :

• Fatigue

• Poor concentration

• Impaired digestion

• Difficult sleep

• Over 40

• Cardiac problems

• Asthma

• Diabetes

• Epilepsy

• Past experience with depression

• Three Mile Island Accident (1979) - a

partial nuclear meltdown accident began at 4.0 am.

• The Chernobyl Disaster (1986) -

catastrophic nuclear accident began at 01.23 am.

• Sinking of the RMS Titanic (1912) – struck an

iceberg at 23.40 (ship time)

• The Union Carbide chemical accident in Bhopal

(1984)– toxic gas leaking from an American-owned

insecticide plant began at 1 am.

Alertness and concentration are lowest at very early morning hours 3 – 6 am.

Be aware of this fact. Work very carefully and deliberately.

Double check everything. Double check verbal orders from your sleepy supervisors also.

Biological

• Sleep deprivation.

• Gastric and digestive disorders.

• Vague symptoms – malaise, irritability, fatigue, muscular pain, not feeling normal, asthma

• Increases in cardio –vascular diseases.

• Poor pregnancy outcome.

• Shift mal-adaption syndrome

Physiological

• Psychomotor performance is significantly affected

• For persons with diurnal orientation, jobs done less efficiently during night –

• Jobs involving vigilance, manual dexterity, boring repetitive tasks, long term memory and fast reaction time.

• Short term memory may improve during night

Social

• Drug and alcohol abuse

• Divorce and souse abuse

• Cut off from the community

• Can not effectively participate in social life

• Can not fulfill collective responsibilities

• All family members can not get together and organize family life

• Neighborhood relations and group entertainment suffer

Less supervision, more independence

at night Less politics

Able to attend day classes

If night-shift allowance is given, increase in income.

More useable daylight hours

• Theoretically, continuous night-shifts are better because youcan adapt your body rhythms to a regular schedule

• In 7 – 8 days circadian rhythm is totally inverted.

• Maintain this schedule consistently on days off too.

• Reverting to a “normal” daytime schedule may harm you.

• Practically because of social and family responsibilitiesmaintaining continuous night life style is never possible.

• Man is a social animal.

• On work days – sleep 8 am to4 pm

• On days off – delay your sleep(sleep form 4 am to noon).

• The anchor period overlaps 4common hours with your nightshift times.

• Better than totally flip floppingbetween days and nights.

• If your shift schedule rotates at short interval, yourbody can not adapt quickly to sudden changes inbiorhythms.

• The goal of split – sleep is to prevent body rhythmsfrom shifting.

• When not working nights, sleep midnight to 8 am

• When working night shifts, split your sleep into 2portions 8 am to noon and 6 pm to 9 pm.

Advantages :

• Two sleep periods help to cancel the “Shift – effect” each has on body rhythms.

• You are sleeping close to end and beginning times of your usual sleep time. This maintains someconsistency with cues.

• Some find sleeping right before shift, helps them stay alert and awake.

• Warm bath prior to bed.

• Sleep in a dark, quiet, cool and comfortableroom.

• DO NOT DISTURB ME.

• Maintain a sleep schedule. Your family membersand friends must know your sleep schedule.

• Develop a pre–bed time ritual – read newspaper,listen to soft music etc. This allows you tounwind from your shift.

Hot drinks tea or coffee. Caffeine is a stimulant.

If scheduled short naps are allowed during the

shift. A short nap of 15 –20 minutes may increase your level of alertness.

Move around. Mild exercise during work.

Wash face with cold water.

Shift workers are move susceptible to

digestive problems. They develop

irregular eating habits. They eat junk

foods.

At night, digestive system is at rest.

Eating at night means eating when your

digestive system is at rest.

Carbohydrates are easily digested in

comparison to fat and protein. Eat more

of carbohydrate rich food at night. Avoid

excessive fat and protein rich food at

night.

Bring easily digestible food from home.

Take small amount at a time. Heavier

meals are more difficult to digest.

Avoid too much caffeine late in your

shift. It can make it hard for you to fall

asleep after you come back home.

Try to eat one meal with family daily.

Establish a meal schedule (normal for

you)

Eat at least 3 meals spaced at consistent

intervals to fuel your body.

1. Limit shift work to essential jobs

2. Schedule toughest most dangerous tasks for early in the shift.Less demanding tasks for later in the shift

3. Avoid scheduling demanding or dangerous tasks at the beginning ofan early morning shift

4. Tailor supervision:• Extra supervision between 3:30 AM and 5:30 AM

• Younger workers have more accidents at the start of a shift followingweekends

• Older workers have more accidents at the end of a shift.

• Supervise inexperienced workers more closely until they learn their job

• Reduce night traffic, noise and

distractions

• Be aware of hazards. Calculate

toxic exposures based upon shift

duration (i.e.: 8H TWA vs. 12 hour

shift)

• Promote alertness:

• Keep area brightly lit

• Reduce glare and reflective surfaces

• If feasible, allow workers to play

music that will keep them awake

• Maximizes safety and health

controls

• Good ventilation

• Temperature control

• Machine guarding

• Avoid isolating workers.

Communicate often.

• Provide food preparation areas,

rest areas, consider and exercise

facility

• Treat shift training like Hazcom

• Talk about health and safety difficulties

• Emphasize performance and accident risks

• Teach employees to recognize social and family problems

Have an enjoy study and see you next week…